Newly Diagnosed... need some guidance

[PML]

Hello Everyone,

I was diagnosed with Type 2 in September (along with high blood pressure, high cholesterol, and gall bladder disease... it's been a fun couple of months for me). I am trying to be as positive as possible with the attitude that... if and when I go down... I'm going down fighting... but... I am beginning to feel overwhelmed and I need some guidance and advice.

A nurse practitioner at my family practice diagnosed me so she has been handling my care. I feel that she may not be knowledgeable enough and has not been pro-active enough so I have changed my next appointment so that I will see one of the doctors in the practice. I have also attempted to get an appointment with an endocrinologist... the first open appointment was January 29th so I set up an appointment with a nurse practitioner in the practice (who specializes in diabetes) on November 6th, until they can work me into the schedule with one of the endocrinologists.

The nurse practitioner has really not given me any information or guidance at all. She put me on a low dosage of metformin in the beginning and now I am on Glipizide. She told me to test 3 times a day (but didn't tell me if those tests should be before or after meals). She told me to eat 6 small meals a day but gave me no guidance on what I should eat or avoid. She told me to start walking 10 minutes a day and work my way up to 30 minutes 3 to 5 times a week. That's it! What I know, I know because my Mother was diagnosed a couple of years ago and because I have begun to research online for myself.

I am convinced that reducing my carbs is going to be crucial in getting my BG under control. Until I started severely restricting carbs (and taking cinnamon with my meals), it was rare for my BG to go below 200 even on Metformin. Since I have been restricting carbs, my numbers are usually below 200 (except occasionally in the morning... it sometimes rises as much as 60 points over night).

My concern is that I keep reading that ketoacidosis is a danger when taking Metformin or Glipizide. Is ketoacidosis related to ketosis? Is it the same thing? Am I endangering myself by restricting carbs and being in ketosis? I have tried to do some research but I have read conflicting opinions. Does anyone know if I should avoid ketosis while taking Meformin or Glipizide?

And... and tips you can give me would be greatly appreciated!!!!! I don't know what I can possibly do to keep my BG from rising at night while I am sleeping! It is so frustrating!

Thank you for any help you may be able to offer!

Phyllis

[Samantha22]

To avoid writing a novel..lol....let me just say that NO...ketosis and ketoacidosis are NOT the same thing.

I'm really surprised and disappointed that an NP gave you poor guidance and information, she should be your information source. I hope that your MD is more helpful.

There are some medical concepts behind bg fluctuations around 3am....so it's not unusual for it to be off in the morning.

Typically, our endocrinologist suggests that our patients who are newly diagnosed test at 3am. I think you'll be surprised at the results. I do realize that it interupts your sleep...but it may add some insight.
Often times, your BG drops, and your body compensates, thus producing a higher reading in the AM...when you'd expect it to be lower.

When you say that you're below 200....what are your typical readings?
Are they suggesting insulin at all?
When are you testing?
I would suggest a fasting AM test and then testing before meals and at bedtime. Once you get into a routine, and your levels become more normal...you'll likely test less.

All this is from a nurses point of view....so others on here who are diabetic may have more input for you as far as those who are "dealing with it"...

I wish you the best of luck.

Oh, do you have a diabetes educator associated with your hospital system?

[PML]

I'm glad to hear that ketosis and ketoacidosis are not the same... I bought some keto stix today and tested. I am solidly in the moderate - mid range of ketosis. I wasn't sure if I needed to eat some carbs to take myself out of ketosis even though that would raise my BG.

I think the NP that I have been seeing is perhaps "out of her element" with diabetes. She keeps having to look things up in her little book. Of course, I can understand if that is the case but she should have handed me over to one of the doctors if she isn't knowledgeable enough to properly care for my condition.

She did talk to me about an insulin injection right before bed to counteract the rise during the night. I was under the impression that she was going to give me a prescription for this but when I filled all my prescriptions, insulin wasn't one of them. I actually called the office to see if she had forgotten... apparently she hadn't... she just decided not to start me on insulin yet.

Since I changed to Glipizide a week and a half ago and started to strictly restrict my carbs, my numbers have been:

146 (just before bed)
207, 132, 138
186, 205, 172, 134, 157, 198 (I was testing some food this day)
178, 140, 149
157, 145
167, 118, 186 (ate 1 corn tostada for dinner)
171, 183, 137, 185
170, 145, 160
182, 230 (after Enterex glucose control drink... yeah, right), 131, 159
153, 128, 150
164, 150, 104 (I was so happy!), 145
135 (lowest am number I've had), 164, 144
169, 148, 140

I was originally testing first thing in the morning, and before lunch, and dinner. When I realized that my am numbers were so high (in the beginning in the 220 to 265 range), I started testing right before bed as well so that I could see what was happening overnight. Then, after doing some research, I started testing first thing in the morning, an hour to an hour and a half after breakfast, lunch and dinner, and right before bed. I also sometimes test for certain foods... before eating, one hour after, and two hours after.

So it is better to test before meals rather than after meals?

Our hospital does have a diabetes education program and I plan to take it. I suspect, however, that it will teach a high fiber / high carb diet. I can already see, from testing, what a negative effect carbs have on my BG.

Thank you SO much for your help!!!

Phyllis

[dancinbr]

Good Morning Phyllis,

There is a wealth of information on this site.

There are a few reference sites as well that will help educate you and how to take care of yourself.

All of us were in "your shoes" at one time or another when we were initially diagnosed.

To start I would offer several URL that will help educate you quite a bit more on this disease.

The first is: http://www.diabetes911.net/

This is Dr. Bernsteins website. I would recommend that you buy his book "Diabetes Solution". Dr. Bernstein is viewed by many of us but not all as the guru in LCing and controlling BG levels. The book is a reference manual that you will go back to many times.

The next site is: http://www.phlaunt.com/lowcarb/index.php

This is a site built by a very dedicated lady; Jenny. She has made controlling diabetes her life work and provides a lot of useful information about this disease.

Then you should read some of our own journals. The can be rather boring but also informative. I was diagnosed March 2007 T2. See my journal.

I followed the path of going LC immediately. I didn't go as strict and regimented as Dr. Bernstein recommends 6-12-12 carbs at Breakfast, Lunch and Dinner respectively. Rather I learned to keep my carbs under 60 grams per day when well disciplined and my upper range was 60-100. If I am being "bad" I will go over.

I tried many different approaches. I settled on Meformin ER 1000mg in the AM and in the PM.

I decided to use insulin Levemir as my basil and Novolog as my bolus very early in my disease.

By LCing in the 30-60 grams of carbs per day I was able to bring my BG levels down to an average of 100-110 per day. I was up over 200 before I started taking care of myself. In fact my first reading in the Doctor's office was over 300.

I found it hard to always stay at 6-12-12, which I followed for the first few months. This is why I decided to begin using insulin both basil and bolus.

Again, read my journal and those of other experienced LCers on this site. You will see a "journal" button that you can press and gain access to anyone with a journal.

I know one particular person cajunboy that has followed a treatment of daily exercise, lost weight and herbs and is doing quite well.

My goal was to get my BG levels below 100 and I have. My A1C went down from 9.3 into the 5's almost immediately upon following the LCing way of life.

Adding insulin allows me to enjoy some more carbs but on the other side really helped my get my numbers under 100. The normal range is 70-85, which is what my target goal is for readings while trying to keep my average under 100.

Oh yes, many of us do have spikes in BG. Spikes are our enemy. This is when damage occurs; anything over 140 is damage.

The other very important thing is to find a Doctor that is willing to work with you. YOU MUST take control of your own disease and find the best way for controlling it that YOU are comfortable doing. Avoid Doctors/Endos who are pushing the ADA way of control. The ADA is so backward and off it is so disappointing. Lately, there are some new revelations that perhaps LCing is the way to treat it, but most have not described low carbing as 6-12-12 per Dr. Bernstein or even 30-60 grams let alone under 100 grams of carbs per day.

This is a start.

Get involved in this community and start following threads and participate. There is a lot of real experience in this forum; good experience so don't be afraid to ask questions; lots of them. But do your homework.

I gave you enough to start. Other folks will offer other advice, books, approaches , etc.

Once again, it is important for you to find you way and figure out how you are going to control your disease. We are all here to help each other.

Best wishes,

Ralph

[TiredFedUP]

Hi Phyllis, I am so glad you are here. I don't want to be a fear monger or a carb-nazi, etc but here's my situation. I'm 32 and mother of two. While my doctor didn't freak out like your nurse practitioner should be doing for you, he did throw up some big red flags when my gestational diabetes didn't exactly disappear. My BG levels were borderline. Before having kids I was always 70s-80s. I've managed to bring everything back to normal by low-carbing, which for me means I don't eat sweets or starches at all. Eliminating all sugar from my diet and switching to meat and fat (I eat a lot of non starchy veggies too) also brought down my triglycerides. Doc doesn't quite understand, but he's happy. That's all fine. Here's the thing that gets me: A couple of months ago my mom died of a diabetes-related stroke at the ripe old age of...62. Her small blood vessels were so fragile from diabetes that she was snuffed out in a matter of seconds. She will never see her grand children grow and play. So when I say I am glad that you found us, I am really glad that you found us. I firmly believe that dietary changes, even if they hurt at first, will bring those sugar levels down. There is a wealth of information on this website. And, you can pose questions. A very interesting one is what is low-carbing? Many people will tell you that its eating less than 20g of carbs per day, which means no sugars, no starches. zip zilch none. Other people have more moderate answers.

In any case, here's a big hug from me to you. Start with getting rid of those carbs, and then start looking at other stuff like caffeine and nicotine (if that applies to you.... stimulants make your body poor sugar into your bloodstream). And do not be afraid of FAT. sugars and to a lesser extent proteins put sugar in your bloodstream. Fat does not. Eating fat encourages your body to switch from sugar as its primary fuel to fat as its primary fuel. Many people on this forum lose weight best when 70-80% of their calories come from fat. Using fat for fuel involves ketone production, which is a good thing when the body does it on purpose. This ketone production caused by a low-carb diet is called benign dietary ketosis, and is a good thing. Ketones are an excellent source of energy and they curb your appetite.

Happy reading, don't forget to visit the recipe section, and I hope to see you in one of the challenges soon. Oh yeah, if you start a journal and post what you are eating, your new support group can come check in on you and pat your back. Chin up, you will get through this. -TFUP

[PML]

Good Morning Ralph,

Thank you so much for the site links and information!

I haven't visited this site for a couple of years... but... when I was diagnosed, I knew exactly where to come first.

I am placing the site links you gave me at the top of my list. (I try to research at least one site a day.) And I will get Dr. Bernstein's book... not sure I will be able to restrict my carbs as severely as he recommends but I am sure his book is full of other great information. Thank you!

Jenny's site is actually one that I found in my research... and I have begun to poke around.

At my last appointment, the NP was talking about putting me on "basil" insulin right before bed to control the spikes I am experiencing during the night (then she didn't). So... what is the difference between "basil" and "bolus"? Sorry... I'm sure I should know this stuff but the NP has given me NO information and when I ask questions she gets pissy with me (I think because she may be embarrassed that she doesn't know the answers).

She started me on Metformin ER 500mg once a day... my numbers were still in the 200's (220's to 260's) on this dosage. At my last visit she changed me to Glipizide XL 5 mg... my numbers have come down but I really think it is more due to me restricting carbs than to the Glipizide. I need to get more aggressive with the medication because I want to get my numbers down in the normal range as quickly as possible. And let's face it... the holidays are almost upon us and I'm bound to slip a little in the carb department so I need my meds to help compensate for that.

My first reading was taken by my Mother, on a visit home, and it was 258 fasting. By the time I got home, got an appointment, got the blood tests back, I was down to 225 fasting. I accomplished this taking cinnamon with meals and watching what I ate (carb wise).

Does taking the insulin make it more difficult for you to lose weight?

Sounds like you have done well to get your numbers in control in just a year and a half... that makes me feel a little more hopeful.

Sounds like our goals are similar... BG levels below 100... A1C in the 5's (my last blood test, my A1C was 10.6... haven't had a 3 month follow-up yet). (In fact, the NP never even mentioned or discussed A1C with me... I had to ask her on my last appointment what mine was and what my goal number should be... she said below 7 but from my research I have decided I would prefer it to be below 6.)

So, if Spikes are our enemy, does that mean that I would be better off having a steady number that is higher until I get my numbers under control?

(My sister recently read a study that found that 4 cups of camomile tea a day can help counteract the damage done by diabetes... so... I have started brewing it in with my iced tea... worth a try.)

I agree... ADA diet and way of control will be a death sentence for me... the problem is finding a doctor/endo that won't try to push the ADA way. We shall see...

Thank you so much, Ralph! You have been a huge help! And you have given me hope that I, too, may be able to get my numbers in line within a year or so... with the help of a more pro-active doctor/endo.

Thank you! Have a great day!

Phyllis

[PML]

Hello TFUp,

I am so sorry to hear about your Mother! 32 is far too young to lose your Mother... and the thought that she will not be there for you and your children is heartbreaking. :tears:

I agree with you... dietary change is key. When my Mother was diagnosed, she refused to change her eating habits. She didn't want to give up any of the things she loved. (She still drinks Coke!!!!) And she refused to exercise at all. She chose to let her meds control her disease. The problem was... the meds didn't control her numbers. It wasn't until I came home and noticed that she was all puffy and swollen and encouraged her to go to the doctor before her next scheduled appointment... and then her cousin and sister came for a visit and had an intervention with her... that she went to the doctor and found out that the cocktail of meds had damaged her kidneys. She was down to 60% kidney function and they had to take her off many of her meds. (Metformin was the first that they eliminated.) In an attempt to control her BG without further damaging her kidneys, her endo put her on glipizide, byetta, and insulin. It wasn't until she started taking byetta that she got all of her numbers (BG, BP, Cholesterol, Triglycerides, etc.) in the normal range... and that is only because it controlled her appetite and allowed her to lose 40+ lbs.

But... here's the kicker... last time I was home (July)... she was eating much less because of the Byetta but what she eats is a problem... she eats mostly carbs (bread, potatoes, rice, pasta, sweets, etc.)... a little meat... almost no vegetables. Although her portion sizes are usually greatly reduced because of the byetta... one day she made chicken and dressing (mostly dressing... cornbread dressing... we are southern)... she piled a large plate as high as possible with dressing. I laughed at her and told her there was no way she was going to be able to eat all that (a 7' muscle bound lumberjack couldn't have eaten all that in a sitting!) But... to my shock and horror... she ate every single bite! So, she is apparently able to eat in spite of the byetta if it is something she really likes.

No nicotine... I quit about 12 years ago. I do get some caffeine from tea, a low carb frappuchino in the mornings (although I have skipped this the past couple of weeks), and an occasional Coke Zero (wish they would make a caffeine free Coke Zero), and lc chai lattes (but I can get caffeine free chai tea bags).

I have never been afraid of fat until recently... a gall bladder attack that sent me to the emergency room thinking I was having a heart attack or stroke (the severe pain shot my blood pressure up to 186 / 107). Until I can have my gall bladder removed, I have to be careful about the fat (especially in combination with carbs). Don't get me wrong... I still eat fat (against NP suggestion)... I just have to be careful or I pay for it.

I have a journal but I haven't posted in it since May of 2006. I started going through some extremely stressful family stuff in mid 2006 and I sort of dropped out and never made it back until now. It just kept getting worse and more things kept happening... until my whole life sort of exploded around Mother's day of this year. I kept telling my husband that my family was killing me... and now I have proof! lol Because, you see, 2 - 3 years ago I know for a fact that my blood pressure and BG were in normal ranges. Although I know that eventually I would have ended up here (because diabetes and high blood pressure runs in my Mother's family)... I thought I had more time to work to prevent development of the disease... however, I think that the extreme and constant stress and depression that my family was causing me hastened the quick progression of my disease.

Thank you for your encouraging words and support... it really means a lot!

(Oh, that reminds me... of course, my triglycerides were high as well.)

Thank you... have a great day!

Phyllis

[Nancy LC]

Sorry... I'm sure I should know this stuff but the NP has given me NO information and when I ask questions she gets pissy with me (I think because she may be embarrassed that she doesn't know the answers).
Wow! This is not someone you want to visit. Not knowing the answers is one thing, but discouraging questions when you have a life threatening disease is almost criminal in my book.

[PML]

Wow! This is not someone you want to visit. Not knowing the answers is one thing, but discouraging questions when you have a life threatening disease is almost criminal in my book.

I agree, Nancy! That is exactly why I have requested one of the doctors for my next visit and have made the step to start seeing an endo. I told my sister that I didn't mind her saying she didn't know the answer to something but that I felt that the next words out of her mouth should have been, "But I will find out and get back to you."

I've been going to this practice since we moved here over five years ago and I have seen this NP on numerous occasions but my visits were all for illness (bronchitis, cold, flu, strep throat, etc.). I have always really liked her and have always felt that NPs are, in general, more caring, attentive, understanding, and better listeners than most doctors. But... I have NOT been happy with her in relation to my diabetes.... I just think she isn't experienced enough in the area.

Hopefully my visit with the doctor on Thursday will be more productive.

Have a great day!

Phyllis

[Nancy LC]

Yeah, generally I think NP's are really good. Maybe this one is just a stinker when you get outside her comfort zone.

[dancinbr]

Good Morning Ralph,

Thank you so much for the site links and information!

I haven't visited this site for a couple of years... but... when I was diagnosed, I knew exactly where to come first.

I am placing the site links you gave me at the top of my list. (I try to research at least one site a day.) And I will get Dr. Bernstein's book... not sure I will be able to restrict my carbs as severely as he recommends but I am sure his book is full of other great information. Thank you!

Jenny's site is actually one that I found in my research... and I have begun to poke around.

At my last appointment, the NP was talking about putting me on "basil" insulin right before bed to control the spikes I am experiencing during the night (then she didn't). So... what is the difference between "basil" and "bolus"? Sorry... I'm sure I should know this stuff but the NP has given me NO information and when I ask questions she gets pissy with me (I think because she may be embarrassed that she doesn't know the answers).

She started me on Metformin ER 500mg once a day... my numbers were still in the 200's (220's to 260's) on this dosage. At my last visit she changed me to Glipizide XL 5 mg... my numbers have come down but I really think it is more due to me restricting carbs than to the Glipizide. I need to get more aggressive with the medication because I want to get my numbers down in the normal range as quickly as possible. And let's face it... the holidays are almost upon us and I'm bound to slip a little in the carb department so I need my meds to help compensate for that.

My first reading was taken by my Mother, on a visit home, and it was 258 fasting. By the time I got home, got an appointment, got the blood tests back, I was down to 225 fasting. I accomplished this taking cinnamon with meals and watching what I ate (carb wise).

Does taking the insulin make it more difficult for you to lose weight?

Sounds like you have done well to get your numbers in control in just a year and a half... that makes me feel a little more hopeful.

Sounds like our goals are similar... BG levels below 100... A1C in the 5's (my last blood test, my A1C was 10.6... haven't had a 3 month follow-up yet). (In fact, the NP never even mentioned or discussed A1C with me... I had to ask her on my last appointment what mine was and what my goal number should be... she said below 7 but from my research I have decided I would prefer it to be below 6.)

So, if Spikes are our enemy, does that mean that I would be better off having a steady number that is higher until I get my numbers under control?

(My sister recently read a study that found that 4 cups of camomile tea a day can help counteract the damage done by diabetes... so... I have started brewing it in with my iced tea... worth a try.)

I agree... ADA diet and way of control will be a death sentence for me... the problem is finding a doctor/endo that won't try to push the ADA way. We shall see...

Thank you so much, Ralph! You have been a huge help! And you have given me hope that I, too, may be able to get my numbers in line within a year or so... with the help of a more pro-active doctor/endo.

Thank you! Have a great day!

Phyllis

Phyllis - The best I can say to you is read and study.

Basil insulin is slow release. I take a dose in the AM and a dose in the PM. The size of the dose is found by trial and error. Keep your LC's low; definitely under 60 is my recommendation and 6-12-12 for awhile as you start to take insulin. Watch your FBG start to come down. Watch your 2 hour after meal numbers start to come down.

When I talk about spikes, I talked about my BG going above 100 into the 140-180 range. So yes, you are in danger with a continuous BG over 200; get it down.

I got mine down with 6-12-12 via Dr. Bernsteins' recommendation. It only took three months for me to get my A1C down from 9.3 to 5.4. I did this with Low Carbs, Metformin ER 1000mg in the AM and 1000mg in the PM plus I was using Janumet for awhile as well.

Over the long term I found it tough to keep up with the 6-12-12 regimen, but I go back to it when I start getting a bit out of control. Do read my journal.

About 6 months into my T2 diabetes I made the personal decision to use insulin. My thought is to emulate what my body used to do. It provides basil insulin and still does so as a T2, but I decided to use insulin to get my numbers down and to get below 100 readings. With LCing and Metformin and Janumet I got down to 100-110 numbers, but rarely below 100. Now I have numbers in the 80s most often and A1C that should approach 5.0. I am trying to emulate what a normal person's profile looks like. Visit Jenny's site more and read Dr. Bernsteins' book.

By the way bolus insulin is fast acting insulin. You use this to "cover" for any carbs in a meal. So, if you find that you are having more carbs than 6-12-12 then cover them with an appropriate dose of fast acting bolus insulin such as Novolog. Again, read Dr. Bernsteins' book since he goes into pain staking detail on how to do all this. You must find the right dose of bolus insulin to cover the grams of carbs in your meal.

The real goal is to tightly control your BG range once it is down where it belongs. So, keeping it in the 8-120 range is ideal. Above 140 that is entering danger territory.

So, how ever you can get to this range either by LCing and exercise alone, adding meds, or committing to using insulin, your goal should be to get down below 140 as soon as you can and ultimately below 120 and close to 100 and longer term below 100.

This is all daunting, but it can happen quite rapidly in less than a year for most folks.

For me, I got my FBG below 130 pretty quick and my everyday readings below 120 in the 100-120 range within a few months. Now, I have my BG most often below 100 and when it goes above I use bolus insulin to keep it down. Bolus, once again, is the fast acting insulin. You have lost this function when you became T2 diabetic.

Read my journal. Read other people's journals. Lots of information here.

Glipizide will be discussed in Dr. Bernsteins' book. Others, might chime in on it, byetta and other Rx's with their experience. I did not use it.

Best wishes, keep posting, ask questions and join in on various threads in progress.

Ralph

[RobLL]

Insulin plus carbs equals the possibility of weight gain. Most of us control this by eating low or very low carb. Hence not much insulin is needed. Low carb equals low (ish) insulin equals no or little weight gain.

[dancinbr]

Insulin plus carbs equals the possibility of weight gain. Most of us control this by eating low or very low carb. Hence not much insulin is needed. Low carb equals low (ish) insulin equals no or little weight gain.

Right RobLL

I have experienced some weight gain and it is because I let my carbs go up.

I have since brought my carbs back down and need less bolus for sure.

If I keep carbs at a meal u following the 6-12-12 Dr. Bernstein approach, I need very little if any bolus insulin.

Remember I am T2 and probably quite insulin resistant.

Ralph

[RobLL]

"Remember I am T2 and probably quite insulin resistant."

This is another (of many) irksome things about being diabetic. Most of us do not know, and it may not be possible to know exactly what our problem is. We guess. The doctor guesses. It does not make a lot of difference in our treatment. Ralph takes larger doses of insulin, I think, because he is resistent to it. I take lower doses because I may be type 1.5, and am still a little resistent, esp. to my regular insulin.

upshot: we use our meter, and do what it takes to keep our BGs in a safe range. Doctors for the most part do not have the patience/time to coach people to do this. It is complicated, so most people settle for far too high BGs.

[PML]

Ralph,

Again, thank you so much! The information that you have given me on your own experience has meant more than you can possibly know. You have really given me hope that it is possible to reach my goals even more quickly than I had hoped. I was telling my sister about you yesterday... and I told her that I felt so much more hopeful, positive, and motivated after learning how quickly you were able to control your numbers.

Thank you, Ralph! Have a great weekend!

Phyllis

[PML]

Insulin plus carbs equals the possibility of weight gain. Most of us control this by eating low or very low carb. Hence not much insulin is needed. Low carb equals low (ish) insulin equals no or little weight gain.

That's good to hear! I was a bit concerned because I know that losing as much weight as possible will be key and the people I know who have gone on insulin have gained lots of weight.

Mom was losing very rapidly after she started on Byetta but when her doctor reduced the Byetta and added insulin, she started gaining weight just as rapidly. (She of course insisted that the Byetta be increased again and the insulin be decreased.) Of course, Mom chooses to control her disease with meds alone... she has refused to change her eating habits, except what has happened naturally due to the effects of the Byetta.

Thanks... this makes me feel more at ease about beginning insulin if needed.


I take lower doses because I may be type 1.5, and am still a little resistent, esp. to my regular insulin.

Type 1.5 ????

[PML]

Update:

I met with my doctor yesterday (switched my appointment from the NP to one of the doctor's in the practice). Oh, what a different experience!!!! I felt so great after leaving!

She was very positive when I told her that I had made an appointment with an endo. She said that even if I decided to return to her for my care, she felt that it was an excellent idea to see an endo and get their input.

She was also nonjudgmental when I told her that I had been following an extremely low carb diet... and when I told her that I felt that the fall in my numbers in the past two weeks was more due to eating low carb than to the glipizide... she agreed. I wasn't expecting that. I was expecting a lecture and opposition when she learned that I was eating low carb. Her acceptance of my choice to go low carb made me feel really positive about her.

She told me that she wasn't going to increase or change my meds since I had an appointment at the endo's in two weeks. I told her that I wasn't comfortable with that. I told her that my numbers were still much too high and that I want to get them down as soon as possible... I didn't want to wait another 2 weeks. I told her that I still had some of the Metformin and a refill or two left and asked it I could start taking the Glipizide (5mg) in the morning and the Metformin (ER 500) in the evening, in an attempt to control the drastic rise overnight. She agreed... so...

Last night I added Metformin to my regimen. (I took it with dinner.) I got so excited when I took my BG just before bed... 121... the lowest I think it's ever been just before bed. So... when I woke this morning, I was so excited to see how low it was going to be... 158! ... what a disappointment! O.K... I know it takes time... I'm just impatient.

So do you think I should take the Metformin just before bed or continue taking with dinner?

Thanks so everyone for their input, suggestions, and advise... it really helps and makes me feel more positive and hopeful for the future.

Phyllis

[dancinbr]

Update:

I met with my doctor yesterday (switched my appointment from the NP to one of the doctor's in the practice). Oh, what a different experience!!!! I felt so great after leaving!

She was very positive when I told her that I had made an appointment with an endo. She said that even if I decided to return to her for my care, she felt that it was an excellent idea to see an endo and get their input.

She was also nonjudgmental when I told her that I had been following an extremely low carb diet... and when I told her that I felt that the fall in my numbers in the past two weeks was more due to eating low carb than to the glipizide... she agreed. I wasn't expecting that. I was expecting a lecture and opposition when she learned that I was eating low carb. Her acceptance of my choice to go low carb made me feel really positive about her.

She told me that she wasn't going to increase or change my meds since I had an appointment at the endo's in two weeks. I told her that I wasn't comfortable with that. I told her that my numbers were still much too high and that I want to get them down as soon as possible... I didn't want to wait another 2 weeks. I told her that I still had some of the Metformin and a refill or two left and asked it I could start taking the Glipizide (5mg) in the morning and the Metformin (ER 500) in the evening, in an attempt to control the drastic rise overnight. She agreed... so...

Last night I added Metformin to my regimen. (I took it with dinner.) I got so excited when I took my BG just before bed... 121... the lowest I think it's ever been just before bed. So... when I woke this morning, I was so excited to see how low it was going to be... 158! ... what a disappointment! O.K... I know it takes time... I'm just impatient.

So do you think I should take the Metformin just before bed or continue taking with dinner?

Thanks so everyone for their input, suggestions, and advise... it really helps and makes me feel more positive and hopeful for the future.

Phyllis

Phyllis,

Everyone is different.

I take Metformin ER 1000mg in the AM and Metformin ER 1000mg in the PM; this is the max dose.

But I also take 40units of Levemir in the AM and 40 units of Levemir in the PM. This is a basil insulin.

I arrived at 40 units AM and 40 units PM by simply following my meter. I started at 5 and 5 and meter tested. After 3 days 10 and 10 and watched my meter and then 15 and 15 and watched my meter, etc., etc., until I saw my numbers under 100 on the meter. Now, I did this while staying 6-12-12 on my carb count so I could keep food from influencing my numbers as much as possible.

I believe I am insulin resistant being way overweight at 270 right now; should be down around 200-210.

I expect as I drop more weight my basil insulin requirement of 40 and 40 will come down.

Go for 100 during the day and go for 120-130 for morning FBG until you finally get going steady. It does take time. But keep LCing while you are trying to see effects of meds and/or insulin.

Best wishes,

Ralph

[RobLL]

Type 1.5 - It is possible for a person to develop the immune or type 1 form of diabetes as they get older. And it is possible for a type 2 to start developing the antibodies that destroy the insulin producing cells.

Here is a quick link: http://www.diagnose-me.com/cond/C12335.html

[veggienft]

Phyllis, I have a theory about the cause and mechanism of type 2 diabetes. You'll find it here:

http://forum.lowcarber.org/showthread.php?t=382421&page=10

Type 2 diabetes is wheat gliadin or milk casein plugging into the nerves which regulate the pancreas's release of insulin. Normally those nerves are judiciously regulated by endorphin. But gliadin and casein mimic endorphin.

Gliadin and casein are large undigested proteins which should not be in the bloodstream at all. They get there because of a learned digestive response to 1) ingested wheat and other glutenous grains, and 2) fungus from undigested sugar. The gut releases a cytokine called zonulin which makes the intestinal wall into a sieve:

http://www.albatherapeutics.com/Default.aspx?tabid=168

I'm absolutely convinced this theory is correct. If you stop eating 1) wheat and other glutenous grains, and stop eating 2) sugar, especially sucrose (table sugar), fructose (from fruit), and lactose (from raw milk), the diabetes should go away, as should the high cholesterol.

Also, start supplementing with vitamin C, vitamin B complex, and a probiotic like plain live yogurt. Omega 3 oil supplements help also.

http://www.food-info.net/uk/intol/hfi.htm
http://www.denvernaturopathic.com/news/celiac.html



The operative question is, what harm can dropping sugar and wheat do?

The answer is, compared to what?

Dropping sugar and wheat could cure your diabetes. I think it will. Following the same drug and dietary therapies which the medical community has prescribed for decades has proven results. It sends people down a lifelong road of worsening diabetes symptoms.

In the absence of prescription medicines, dropping sugar and wheat won't harm you. The only problem I can foresee ......If a no-sugar no-wheat diet lowers your blood insulin, sugar, and cholesterol levels while you're on drugs which are doing the same things, the drugs could cause you a problem.

Consult a doctor if that's the case.

Good luck.

..

[veggienft]

You probably scanned my solution to diabetes, and said "so what? It says to stop eating sugar........

........not hap'nin".

It can happen if you stop eating wheat. The theory centers around the fact that proteins in wheat and milk plug into nerve endorphin receptors. These proteins are opioids. The addictive effects are what make you crave the foods which cause them ........sugar and wheat.

Stop eating wheat when you stop eating sugar. The cravings subside much faster, and stay gone better.

..

[Nancy LC]

I believe that wheat (gluten actually) is pretty evil stuff, having found a gluten sensitivity or perhaps celiacs in myself and having done lots of research, but I don't think it is the total solution to Type 2 diabetes or insulin resistance. I think that it has to be part of an overall program to lower total carbohydrates, especially grains (gluten or not, whole or refined) and sugars and especially high levels of fructose in particular.

For me, I found much better health in jettisoning all grains, dairy too to some extent and concentrating on eating animal proteins and non-starchy veggies, with low sugar fruits from time to time. I'm trying to eliminate most if not all vegetable oils, except olive and coconut (and perhaps peanut).

[veggienft]

There's pretty solid information that sugar is bad for people. There are a lot of interpretations of why that's true. They implicate mechanisms from digestive microorganisms to the "metabolic pathway" to autoimmune reactions.

The medical system charged with finding the mechanism is broken. Those of us who have tried low-carb diets know they work because low-carb diets help the symptoms. But low-carb diets drive most people .......absolutely.........

........CRAZY!!!!!!

That's both the biggest symptom and the biggest obstacle. It's how most doctors get away with telling people to keep eating carbs........ "Just cut back on everything". The phrase feeds patient addictions and doctor careers.

Why would doctors look for a cure when the money is in "treatment"?

The public will only accept low-carb if the medical profession does. The medical profession will only accept low-carb if it's proven, and crammed down their throats.

And we won't get proof without a solid testable model.

The stomach converts starches into sugars. People who have trouble with sugar go low-carb, and their health improves tremendously. So they attribute the improvement to lower blood sugar levels.

Not so fast. "Carb" foods contain other things, and sugar has other effects. We're looking for causes for effects from celiac disease to diabetes, arthritis, autism, schizophrenia, lupus, multiple sclerosis, cancer and many others.

And we're looking for a solid provable cause of food addiction. The fact that people crave sugar does not mean that blood sugar is the source of sugar addiction.

People cite Dr. Simoncini. He claims cancer is candida, because when he treats for candida the cancer gets better. Their opponents poopoo Simoncini's claim, because there's solid evidence that cancers are other things. Then why does treating candida help cure cancer?

Humans are hosts to fungal colonies. Fungi are extremely adept at adapting to survive in higher order animals like humans. So we have evolved, not to defeat fungi, but to adapt to it. Humans did not evolve in the expansion of modern agrarian societies. In fact evolutionary changes are impossible in an expanding population. They only occur in devastatingly harsh, killing environments.

Candida is a particularly sneaky fungus. It feeds on sugar. Candida gains a foothold in humans who eat agrarian carbohydrates. Candida infestation is a product of a modern agrarian diet. Coincidentally, autoimmune disease is also linked to modern lifestyle.

Autoimmune diseases, by definition, are diseases of molecular mimicry:

* An antigen attacks tissue. The body attacks the antigen and the tissue.
* An antigen attacks tissue. The body fails to distinguish the antigen from the tissue.
* An antigen mimics tissue. The body attacks the antigen and the tissue.
* An antigen mimics tissue. The body fails to distinguish the antigen from the tissue.

........but add one more.........

* An antigen mimics food. The body treats the food as an antigen

The body responds by attacking the food and the tissue it considers compromised. That's what happens when an advanced animal eats food which he/she did not evolve to eat.

Virses, bacteria and fungi all thrive on sugar in the intestines. Viruses and bacteria attack with single genetic signatures. Fungi attack in colonies with scores of genetic signatures, scores of attempts at finding a niche. Active candida colonies can grow on spikes through the intestinal wall. The human body's primary response is to open the spike channels, and rinse the candida into the bloodstream. The blood's immune system then kills the candida.

This is an "adaptive" response which the immune system commits to its "innate" memory.

But candida evolves to mimic wheat gluten. So a candida-compromised digestive system rinses its contents into the bloodstream every time the host eats wheat.

Wheat gluten and a few other dumped glycoproteins are dangerous opioids, mimickers of endorphin. Because wheat gluten is such a dangerous, complex protein, the blood's immune system gets overwhelmed ........too overwhelmed to handle the gluten, the other dumped antigens, or the candida.

Gluten's opioid quality is precisely why people resist abstaining from wheat and sugar. Humans suffer, but the candida survives.

We have internet forums with people pointing at celiac disease. They abstain from wheat, and continue to feed sugar to their candida infections. We have internet forums with people pointing at candida. They starve their candida infections of sugar, but fail to eliminate wheat. And we have internet forums with people pointing at blood sugar. They cut back on carbs, but continue to put small amounts of wheat and sugar into their stomachs.

Virtually all the tests performed on the link between autoimmune diseases, wheat gluten and sugar have successfully linked them. Any one of these tests cannot prove causality, but in the aggregate, that's exactly what they prove.

..

[chandbaby1]

I eat very low carb and have given up sugar long time back. Although i see some improvements ...I am not cured.

there are a lot of peices to the puzzle. It is foolish to think wheat and sugar and milk products are the answer to everything. But it is foolish if you dont try to eleminate and see if you get better too.

[Nancy LC]

Eating a low carb diet, or a gluten free/sugar free (or whatever) diet, isn't a cure even if it works. It's a treatment. If you stop the treatment, then the problems come back.

Veggienft you sound like me back when I first discovered my gluten issues. :) I probably would have tried to preach to everyone that every problem they have is because of gluten but I'm old enough to realize how fruitless that generally is. When you clobber people on the head with information they aren't interested in hearing they block it out. The more you push, the more they block. I cautiously offer advice, sometimes obliquely, and share gems I find on the Interwebz when someone seems receptive. I've converted a few folks to gluten free with a timely suggestion to try a gluten free diet for a few weeks to see if things improve. But if they balk I don't push. Still haven't gotten any luck in getting any family members to try but there's quite a few of us on this forum that are GF and another batch that are CF (or both).

Oh and a low carb paleo style diet isn't such a onerous thing, IMHO. I've been getting along quite nicely on LC for 5 years now, don't really miss the starches and sugars at all. But I'm a good cook and could make cardboard fairly appetizing I think.

[eddiemcm]

"But I'm a good cook and could make cardboard fairly appetizing I think."
Interesting.A cardboard diet?
<chuckle>
Eddie

[Nancy LC]

"But I'm a good cook and could make cardboard fairly appetizing I think."
Interesting.A cardboard diet?
<chuckle>
Eddie
If nothing else, I could soak it chicken broth, pound it out thin and make a wrap out of it. :)

[veggienft]

I eat very low carb and have given up sugar long time back. Although i see some improvements ...I am not cured.

there are a lot of peices to the puzzle. It is foolish to think wheat and sugar and milk products are the answer to everything. But it is foolish if you dont try to eleminate and see if you get better too.


If you drip acid on your skin, it harms you. If you remove the acid drip, it doesn't cure you. It "treats" you by removing the cause. If you return the drip, the harm returns.

Replacing the acid with some substitute acid is a "treatment", but it doesn't work. Turning down the acid flow helps, because it inhibits the cause.

Sugar damage comes from growing gut fungus. Gut sugar comes from all carbs, but it's exponentially worse from pure sugars. Because candida mimics gluten, the zonulin dump can come from either sugar or wheat. Blood wheat is far more damaging than blood sugar.

Wheat causes sugar addiction. We can eliminate wheat. We can only control sugar.

..

[PML]

Ralph, Thanks again for all the info!


RobLL, Thanks for the link to info on Type 1.5!



Phyllis, I have a theory about the cause and mechanism of type 2 diabetes. You'll find it here:

http://forum.lowcarber.org/showthre...=382421&page=10

Sorry, Veggienft... I didn't see a post from you, detailing your theory, on page 10 of that thread. Perhaps it has been bumped to a different page.

Thank you for all the information links. I skimmed them and will read them in detail when I have more time.

I am eating low carb so I have already eliminated wheat, sugar, and milk from my diet (although I do still eat cheese, occasionally yogurt, and use buttermilk for breading, marinating chicken, and salad dressing... baby steps).... so far... not a cure... and I'm sorry to say that my cravings for things made with wheat and sugar have not gone away... don't think they ever will. This isn't the first time that I have gone low carb. I have known most of my life that it is the way I should eat... it's just been very difficult for me to stick with it long term. But... now... I have a bit more incentive to stick with it this time... since I have been diagnosed with diabetes... I want to live... and I know that eating the ADA way will kill me.

So... are you a diabetic that has "cured" your diabetes with these eliminations from your diet? If so, how wonderful!!! And, if so, how long did it take you to "cure" your diabetes? So, am I to understand that you are a "former" diabetic and that you control your blood sugar and maintain it within a "normal" range without medication simply by eliminating wheat, sugar, and milk from your diet?

Thanks again for all the information!


Phyllis

[veggienft]

I have a history of hypoglycemia, panic, Wolf Parkinson White heart arrhythmia, chronic heartburn, chronic sinusitis, muscle cramping, "brain fog". I grew up before the ADD diagnosis was in vogue, but........ I've never been diagnosed with depression for good reason ......... tags stick to people even when they're cured.

I didn't want to get into hypoglycemia because it's widely misunderstood. "Hypoglycemia" literally means low blood sugar. But clinically, it's characterized by wide swings in blood sugar. I ascribe those swings to gluten-induced zonulin dumps.

Everyone with type 2 diabetes went through a period of hypoglycemia. That's why some people erroneously refer to hypoglycemia as "pre-diabetes". But there are probably as many people with hypoglycemia who never get type 2 diabetes. I'm one of them ......because I'm fortunate enough that sugar ingestion makes me stomach-sick.

By 30-something years old, I was weaning from milk and sugar. Only decades later, after suffering most of the above symptoms, I discovered that wheat ingestion was integral to the cause.

As I explained in my diabetes rant, type 2 diabetes is a form of "gluten sensitivity" .....so designated, not because it's docile, but because the type 2 diabetic gluten attack occurs with no ongoing immune response.

Genetically type 2 diabetics are different from celiacs. Celiacs have an ongoing digestive immune reaction to wheat. Genetically, I'm not "gluten sensitive". I have celiac disease, and I'm "gluten intolerant".

Celiac disease is unique. Since its discovery celiac disease has been recognized as the only autoimmune disease with a proven genetically-linked cause. So we have a giant western society with literally scores of autoimmune diseases which medical science has been studying for decades .......And so far we've discovered only one cause........

Wheat.

Celiac disease is the key to autoimmune disease .......ALL autoimmune disease.

Wheat disease is characterized by zonulin-forced membrane permeability. But don't get me wrong. Aging is characterized naturally by membrane permeability. Most of us will eventually succumb to permeability-caused autoimmune disease. But naturally, that should happen many years later than most westerners experience it.

Best of luck with your diabetes.

..

[PML]

Veggienft,

Thank you for all the information. Information is power! You have given me some things to think about and research in the future. Time invested in gaining knowledge is never wasted. And... gaining as much knowledge as possible is crucial for me because I am not only fighting for my own life but also for the lives of two younger sisters and a younger brother that I think are all doomed to follow in my footsteps unless I can get them to make some drastic changes now.

Thank you... have a great day!

Phyllis